Reduction of Ventricular Size after Shunting for Normal Pressure Hydrocephalus Related to CSF Dynamics before Shunting

✓ Cerebrospinal fluid (CSF) dynamics were correlated to the changes in ventricular size during the first 3 months posttrauma in patients with severe head injury (Glasgow Coma Scale score ≤ 8, 75 patients) to distinguish between atrophy and hydrocephalus as the two possible causes of posttraumatic ventriculomegaly. Using the bolus injection technique, the baseline intracranial pressure (ICP), pressure volume index, and resistance for CSF absorption (R0) provided a threedimensional profile of CSF dynamics that was correlated with ventricular size and Glasgow Outcome Scale (GOS) score at 3, 6, and 12 months posttrauma. Patients were separated into five different groups based on changes in ventricular size, presence of atrophy, and CSF dynamics. Group 1 (normal group, 41.3%) demonstrated normal ventricular size and normal ICP. Group 2 (benign intracranial hypertension group, 14.7%) showed normal ventricular size and elevated ICP. Group × (atrophy group, 24%) displayed ventriculomegaly, normal ICP, and normal R0. Group 4 (normal-pressure hydrocephalus group, 9.3%) had ventriculomegaly, normal ICP, and high R0. Group 5 (high-pressure hydrocephalus group, 10.7%) showed ventriculomegaly and elevated ICP with or without high R0. The GOS score in the nonhydrocephalic groups (Groups 1, 2, and 3) was better than in the hydrocephalic groups (Groups 4 and 5). It is concluded from these results that 44% of head injury survivors may develop posttraumatic ventriculomegaly. Posttraumatic hydrocephalus, as identified by abnormal CSF dynamics, was diagnosed in 20% of survivors and their outcome was significantly worse. This study demonstrates the importance of using CSF dynamics as an aid in diagnosis of posttraumatic hydrocephalus and identifying those patients who may benefit from shunt placement.

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Cognitive profiles based on MRI ventricular size measurements in patients with idiopathic normal pressure hydrocephalus and Alzheimers disease. Implications for a diagnostic approach

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.119556 ◽

2021 ◽

Vol 429 ◽

pp. 119556

Author(s):

Roberta Terranova ◽

Antonina Luca ◽

Giulia Donzuso ◽

Giovanni Mostile ◽

Roberta Manna ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Diagnostic Approach ◽

Cognitive Profiles ◽

Ventricular Size ◽

Alzheimers Disease

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Three-day CSF drainage barely reduces ventricular size in normal pressure hydrocephalus

Neurology ◽

10.1212/wnl.0b013e31825fdf8a ◽

2012 ◽

Vol 79 (3) ◽

pp. 237-242 ◽

Cited By ~ 18

Author(s):

N. Lenfeldt ◽

W. Hansson ◽

A. Larsson ◽

R. Birgander ◽

A. Eklund ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Ventricular Size ◽

Csf Drainage

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Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus

Journal of Neurosurgery ◽

10.3171/jns.2004.100.6.1036 ◽

2004 ◽

Vol 100 (6) ◽

pp. 1036-1040 ◽

Cited By ~ 24

Author(s):

Ullrich Meier ◽

Sven Mutze

Keyword(s):

Clinical Outcome ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Ventricular Volume ◽

Communicating Hydrocephalus ◽

Ventricular Size ◽

Content Type ◽

Shunt Placement ◽

Postoperative Change ◽

Fine Print

Object. It is well known that in patients with communicating hydrocephalus or normal-pressure hydrocephalus (NPH), ventricular size decreases following implantation of shunts with differential pressure valves. The aim of this study was to determine whether ventricular size correlates with a positive clinical outcome following shunt placement. Methods. Hydrostatic valves (dual-switch valves) were implanted in 80 patients with NPH at Unfallkrankenhaus, Berlin, between September 1997 and January 2002. One year postoperatively, these patients underwent computerized tomography scanning, and their ventricular size was ascertained using the Evans Index. Among 80% of the patients who showed no postoperative change in ventricular volume, 59% nonetheless had good to excellent clinical improvements, 17% satisfactory improvement, and 24% no improvement. Furthermore, a moderate reduction in ventricular size was observed in 14% of patients in this cohort. Among these, 36% experienced good to excellent clinical improvements, 28% satisfactory improvement, and 36% unsatisfactory improvement. A marked reduction in ventricular size was observed in 6% of the patients. Of this latter group, 60% demonstrated good to excellent outcomes, whereas 40% had unsatisfactory outcomes. Conclusions. Favorable outcomes following the implantation of a hydrostatic shunt in patients with NPH did not correlate with decreased ventricular volume 1 year after surgery. In fact, better clinical outcomes were observed in patients with little or no alteration in ventricular size, compared with those in patients with a marked decrease in ventricular size. A postoperative change in ventricular volume should be assessed differently in patients with NPH compared with those suffering from hypertensive hydrocephalus.

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Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement

Journal of Neurosurgery ◽

10.3171/jns.2002.97.1.0073 ◽

2002 ◽

Vol 97 (1) ◽

pp. 73-79 ◽

Cited By ~ 35

Author(s):

Richard C. Anderson ◽

Jessica J. Grant ◽

Robert de la Paz ◽

Steven Frucht ◽

Robert R. Goodman

Keyword(s):

Clinical Improvement ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Ventricular Volume ◽

Ventricular Size ◽

Content Type ◽

Shunt Placement ◽

Lateral Ventricles ◽

Fine Print ◽

Volumetric Measurements

Object. The syndrome of normal-pressure hydrocephalus (NPH) refers to the clinical triad of gait disturbance, dementia, and urinary incontinence in association with idiopathic ventriculomegaly and normal intracranial pressure. Ventriculoperitoneal (VP) shunt placement often yields significant clinical improvements, sometimes without apparent reduction of ventricular size. The authors hypothesized that careful volumetric measurements would show a decrease in ventricular volume in these patients. Methods. Twenty consecutive patients with NPH underwent placement of VP shunts equipped with programmable valves. In 11 patients pre- and postoperative neuroimaging was performed, which allowed volumetric analysis. Volumetric measurements of the lateral ventricles were calculated in triplicate by National Institutes of Health image-processing software to assess standard computerized tomography (CT) scans (eight patients) or magnetic resonance (MR) images (three patients) obtained before and after shunt placement. Ventricular volumes were also assessed by an independent neuroradiologist. Postoperative studies were performed at a time of clinical improvement, between 1 and 9 months postsurgery (mean 5 months). Preoperative and postoperative Unified Parkinson's Disease Rating Scale evaluations were performed in four patients. Significant clinical improvement occurred in all patients after shunt placement (mean follow-up period 17.5 months). Although 10 (91%) of 11 patients demonstrated a calculable decrease in volume in the lateral ventricles (mean decrease 39%), formal interpretation of neuroimages indicated a definite decrease in lateral ventricular volume in only three (27%) of 11 patients. Conclusions. Volumetric measurements obtained to compare preoperative and postoperative CT or MR studies obtained in patients with NPH in whom clinical improvement was seen after shunt placement surgery show a demonstrable decrease in ventricular size. Volumetric measurements may be helpful in clinical assessment postoperatively and in guiding programmable valve pressure settings.

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CSF Dynamics in Patients with Suspected Normal Pressure Hydrocephalus

Intracranial Pressure VII ◽

10.1007/978-3-642-73987-3_101 ◽

1989 ◽

pp. 379-382 ◽

Cited By ~ 7

Author(s):

E. J. Delwel ◽

D. A. de Jong ◽

C. J. J. Avezaat ◽

J. H. M. van Eijndhoven ◽

A. Korbee

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Csf Dynamics

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Variations of intraventricular pressure during pneumoencephalography

Journal of Neurosurgery ◽

10.3171/jns.1974.40.1.0101 ◽

1974 ◽

Vol 40 (1) ◽

pp. 101-106 ◽

Cited By ~ 6

Author(s):

Jacques Philippon ◽

Bernard George ◽

Jean Metzger

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Normal Pressure Hydrocephalus ◽

Initial Pressure ◽

Normal Pressure ◽

Intraventricular Pressure ◽

Csf Dynamics ◽

Content Type ◽

Fine Print

✓ Intraventricular pressure was studied in eight patients during and after diagnostic pneumoencephalography. In cases with normal initial pressure and normal cerebrospinal fluid (CSF) dynamics, variations in pressure were moderate, immediate, and disappeared at the end of the examination. In cases of normal-pressure hydrocephalus, there was a slow but relatively important elevation that continued for at least 24 hours. In cases with intracranial hypertension, there was a rapid significant increase; return to normal depended principally upon the flow from a large CSF compartment.

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A venous mechanism of ventriculomegaly shared between traumatic brain injury and normal ageing

Brain ◽

10.1093/brain/awaa125 ◽

2020 ◽

Vol 143 (6) ◽

pp. 1843-1856 ◽

Cited By ~ 4

Author(s):

Toshihiko Aso ◽

Genichi Sugihara ◽

Toshiya Murai ◽

Shiho Ubukata ◽

Shin-ichi Urayama ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Normal Pressure Hydrocephalus ◽

Venous Drainage ◽

Normal Pressure ◽

Common Mechanism ◽

Causative Role ◽

Ventricular Size ◽

Brain Ageing ◽

Normal Ageing

Abstract Recently, age-related timing dissociation between the superficial and deep venous systems has been observed; this was particularly pronounced in patients with normal pressure hydrocephalus, suggesting a common mechanism of ventriculomegaly. Establishing the relationship between venous drainage and ventricular enlargement would be clinically relevant and could provide insight into the mechanisms underlying brain ageing. To investigate a possible link between venous drainage and ventriculomegaly in both normal ageing and pathological conditions, we compared 225 healthy subjects (137 males and 88 females) and 71 traumatic brain injury patients of varying ages (53 males and 18 females) using MRI-based volumetry and a novel perfusion-timing analysis. Volumetry, focusing on the CSF space, revealed that the sulcal space and ventricular size presented different lifespan profiles with age; the latter presented a quadratic, rather than linear, pattern of increase. The venous timing shift slightly preceded this change, supporting a role for venous drainage in ventriculomegaly. In traumatic brain injury, a small but significant disease effect, similar to idiopathic normal pressure hydrocephalus, was found in venous timing, but it tended to decrease with age at injury, suggesting an overlapping mechanism with normal ageing. Structural bias due to, or a direct causative role of ventriculomegaly was unlikely to play a dominant role, because of the low correlation between venous timing and ventricular size after adjustment for age in both patients and controls. Since post-traumatic hydrocephalus can be asymptomatic and occasionally overlooked, the observation suggested a link between venous drainage and CSF accumulation. Thus, hydrocephalus, involving venous insufficiency, may be a part of normal ageing, can be detected non-invasively, and is potentially treatable. Further investigation into the clinical application of this new marker of venous function is therefore warranted.

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